Project Summary/Abstract This application, responding to the Notice of Special Interest (NOSI) regarding the Availability of Administrative Supplements and Urgent Competitive Revisions for Research on the 2019 Novel Coronavirus (NOT-DA-20-047), requests an administrative supplement to the Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD, CTN-0102). The main purpose of the parent project is to investigate the impact of telemedicine (TM) on MOUD access and retention for individuals with OUD in rural primary care settings. The coronavirus disease 2019 (COVID-19, or COVID for short) pandemic has forced many health care systems to rapidly implement remote care models, which is of direct relevance to this project. Building upon the existing research plan, we request an administrative supplement to conduct a thorough investigation of COVID?s impact on TM practices and access to MOUD in rural communities. In addition to characterizing changes in attitudes and perceptions regarding TM for OUD treatment, we will investigate and assess the impact of COVID over the next 2 years with regard to changes in MOUD access and services (especially TM) in rural primary care settings and in OUD patients? use of substances (particularly opioids) and health conditions. Study specific aims include: Aim 1. To assess changes in MOUD access and services (especially TM) in rural primary care settings over the COVID pandemic, and Aim 2. To assess changes in OUD patients? substance use (particularly opioids) and health conditions over the COVID pandemic. The supplement funding will support (1) qualitative data collection and analysis that includes focus groups and semi-structured interviews to document COVID impact from the perspective of community stakeholders, providers, and patients drawn from primary care clinics serving rural communities, and (2) quantitative data collection and analysis that includes health records for patients served by the rural primary care clinics as well as self-report from OUD patients? participant surveys to investigate COVID impact on the use of healthcare, TM, and substances. Findings will contribute to scientific knowledge regarding COVID impact, responses, and consequences in rural communities, as well as to inform and shape future development of remote care models.